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What does it mean to not have health insurance in the US?


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#21 SiCrane   Moderators   -  Reputation: 9496

Posted 25 April 2013 - 05:16 PM

Depending on your state and county, you may have options like public aid or other reduced cost health care through government organizations. In my state application for these kinds of programs are done at the state level, but services administered at the county level, with state funding going to the county. You can get minimal dental and medical coverage on a sliding scale based on your income, though I think two or three rounds of budget cuts ago it was made so that even those with no income required co-pays, so it's not free. For drug prescriptions, I worked in the pharmaceutical industry for a while and I know that some companies offer private patient assistance for people who are poor enough that they can't afford their prescriptions and well off enough that they can't get public aid.

Edited by SiCrane, 25 April 2013 - 06:53 PM.
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#22 Prinz Eugn   Crossbones+   -  Reputation: 3558

Posted 25 April 2013 - 05:29 PM

The US health care system is massively inefficient, but "free" health care doesn't exist, contrary to the impression you'd get from some of the posters was I think frob's point.

 

The point of this is that even for countries like the UK or Sweden or Australia or Canada, health care is not free, but is instead paid for via taxes.

 

I probably shouldn't have used the term free, what I meant was "NHS will cover it without you having to give them money directly, unlike cosmetic surgery etc". Assuming http://www.usgovernmentspending.com/ is accurate wouldn't that mean a large % of US taxes goes to health care too and if you compare the total spending 18% of UKs budget goes on health care, where as (according to that link) 19% in USA. Wouldn't this mean US pay for health care in both taxes AND insurance?

Yeah, our system is ridiculously inefficient, hence health care reform popping up pretty often as a political issue, but I think the point was that it's misleading to say "Well in my home country, it's free (or super cheap)" because that's simply not true.


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#23 Khaiy   Crossbones+   -  Reputation: 1342

Posted 25 April 2013 - 07:37 PM

Yeah, our system is ridiculously inefficient, hence health care reform popping up pretty often as a political issue, but I think the point was that it's misleading to say "Well in my home country, it's free (or super cheap)" because that's simply not true.

 

Meh. The US has very high prices for just about every possible medical procedure compared with other countries. While other countries tend to also have better insurance options than the US the procedures tend to be less expensive as well, which has a very dense and complicated relationship with the costs of the procedures themselves and the insurance that is available. I would much rather get an MRI in France, for instance, than in the US regardless of any insurance considerations, buy prescriptions in Canada, see a specialist in Japan, and so on. Hell, you can't even get a price quote for most medical services in the US without having an insurance policy.

 

Again, insurance is about risk tolerance and your individual budget. Insurance companies employ legions of actuaries whose sole purpose is to remove all possible arbitrage opportunities from you, the individual consumer. This is especially true on the individual market. There are a couple of advantages a consumer can leverage against insurance companies, but I don't know of any that the OP could use given the situation he describes.

 

Other peoples' experiences (with insurance coverage and insurance prices, cost sharing, and anything else) tend not to be informative for any given individual unless you're very careful in accounting for a lot of factors. Don't be dazzled or awed by prices other people pay. As someone posted above, your options will likely expand on January first of next year, though unpredictably so. For now, if you are uninsured, here's my checklist:

 

1. Check for any sort of government assistance. You will not get a better coverage:value ratio on the individual market, even in a stingy state, if you qualify for assistance. Contacting your county human services office is the best way to figure this out.

 

2. If you can't get assistance, ask insurers in your area for quotes on individual policies and make sure you get the following numbers for each plan offered: monthly premium, deductible, co-insurance rate, and out-of-pocket maximum.

 

3. Think about how often you need routine medical services (a physical, eye exam, dental visit, etc.) in a given period of time and add the per-visit costs (co-pays and anything under the deductible figure at a minimum) for these visits to the total premium costs for that period.

 

4. If you can't afford the amount listed in 3 for a given plan, remove it from consideration. If there are any plans left to choose from, you'll have to estimate your level of comfort with risk. Less risk = more money spent per month regardless of any medical services you access.

 

5. Locate clinics in your area and, more importantly, non-ER urgent care centers. Use these as needed, and avoid hospitals and emergency rooms unless you are truly having a health emergency (if in doubt, go to an ER).



#24 Hodgman   Moderators   -  Reputation: 28595

Posted 25 April 2013 - 07:41 PM

I think the point was that it's misleading to say "Well in my home country, it's free (or super cheap)" because that's simply not true.

if similar amounts of tax go into healthcare, and then you pay that same amount again on insurance, then that makes other countries about twice as cheap, which is just super.
And, what about the fact that when you don't pay tax, you can still get a doctor to remove your spleen? That's the "free" part. Lose your job: none of this panic.
This past financial year, I've been working on my own project with a tiny bit of contracting to get by, which means I'm way under the tax threshold of $18k, so I pay zero tax on my income. When i go shopping i of corse still pay GST(VAT) and other minor public revenue streams, but I can still get a free general practitioner, or a blood test, or help in paying for a specialist like a shrink as long as a GP writes a referral, and if I need complex surgery I can go on a public waiting list, or if I'm injured I can go to the ER and be X-Rayed ands treated.
By paying through tax, which is within everyone's means (no income like me right now = no means so no tax, or later if I make millions I'll be earning way beyond my own needs so I'll pay higher tax), yes, some people do get free healthcare and everyone has a doctor when they need one.


Trying to attack free healthcare on that ground is like trying to argue that public roads and toll roads are the same, when they're obviously very different. You don't need a tax payment receipt to get on to a public road, despite it being created through taxes.

 

There's also big differences in where your money goes. Excessive taxation goes to a not-for-profit service provider with a motivation to do well by their customers. Excessive insurance payments go to some rich shareholder with a motivation to take as much money as they can from you.


Also, in a lot of these countries, foreign tourists get the free healthcare too, despite obviously having payed no tax.
Meanwhile, a friend of mine that went to the US got a bad flu and went to a doctor, who recommended a flu vaccine while he was there. He was billed over $1k for being uninsured! At a private doctor here (not part of the free system) you'd expect the shot at near cost price ($20-$100) and the consultation to be around $60. That's a super big difference.


Edited by Hodgman, 25 April 2013 - 09:01 PM.


#25 BladeOfWraith   Members   -  Reputation: 245

Posted 25 April 2013 - 07:42 PM

Well first of all, US law is going to mandate health health insurance on January 1st, so this isn't exactly a long term question.

A $95/%1 fine isn't particularly daunting.


Edited by BladeOfWraith, 25 April 2013 - 07:50 PM.

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#26 Prinz Eugn   Crossbones+   -  Reputation: 3558

Posted 25 April 2013 - 10:04 PM

Um, the health care system we have in the US is pretty terrible, I'm not saying it's not.

 

I'm just agreeing with what I think frob is trying to say, which is that even though your immediate out of pocket expense might be low or non-existent doesn't mean it's free, it means you and/or someone else is paying for it somewhere else. Which isn't incompatible with it also being a good idea (since our semi-private system is incredibly inefficient, as I said).


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#27 Alpha_ProgDes   Crossbones+   -  Reputation: 4688

Posted 25 April 2013 - 10:18 PM

Well first of all, US law is going to mandate health health insurance on January 1st, so this isn't exactly a long term question.

A $95/%1 fine isn't particularly daunting.

 

That fine increases every year, IIRC.


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#28 breadroll   Members   -  Reputation: 102

Posted 26 April 2013 - 11:16 AM

It means almost nothing... unless you get sick or run over by a car. My family skated by for years without health insurance. We even had two babies while uninsured. We lucked out and came out ahead. We saved far more by not paying insurance premiums than we paid on checkups, vaccinations and even the delivery of two babies. If my wife had to have a c-section or there were other complications things would have been quite different.

 

Edit: Also, if you just lost your insurance and you want continued coverage, look into COBRA coverage.

Wow, so it is really possible to not have an insurance coverage until you get old. I know without insurance is financially risky but then seeing this post makes me think that I can still live without insurance. The amount of insurance we avail these days is really something these days so I think if you're not an accident prone magnet, you can still live without having to pay for insurance.


Edited by breadroll, 28 May 2013 - 01:46 AM.


#29 frob   Moderators   -  Reputation: 19774

Posted 26 April 2013 - 05:11 PM

Wow, so it is really possible to not have an insurance coverage until you get old. I know without insurance is financially risky but then seeing this post makes me think that I can still live without insurance. The cost of insurance is really something these days so I think if you're not an accident prone magnet, you can still live without having to pay for insurance.

Um, how about no.

 

Being an "accident prone magnet" has nothing to do with it.  You can be safely enclosed in your bunker where all objects are padded, and yet still develop cancer or other medical conditions.

 

There are some people who insist in never getting medical help because it is contrary to their religious beliefs.  If that person is an adult and they choose to ignore medical treatment, that is their choice.  If that person is a child, you better get medical help.

 

 

I know that as a late-teen and twenty-something single adult you are invincible.  Nothing will happen to you.  I lived through that age, too.   Then I grew up.

 

... Somebody ran a red light, t-boned my car, and put my wife in the hospital.  

 

... Or a few years ago when my dad had a headache and dizziness, his co-workers made him go to the hospital, and three hours later they were preparing for emergency surgery to try to remove the brain cancer that ultimately killed him.

 

 

 

You may think you are fine.  But kinda by definition you cannot predict medical health emergencies.  Those are also the most expensive, and the biggest benefit to having health insurance.

 

Not having health insurance is a terrible risk.  You can play the numbers game, but if you happen to lose the loss may be permanent.


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#30 VladR   Members   -  Reputation: 722

Posted 07 May 2013 - 03:02 PM

The cost of insurance is really something these days so I think if you're not an accident prone magnet, you can still live without having to pay for insurance.

In U.S., this is an incredible Russian roulette you are playing with your life. The inevitable bankruptcy (in case sh*t happens) is a pretty serious thing that has an impact on the rest of your life.

 

I really hope, that when you grow up and have kids, you won't play that game with your poor kids...


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#31 tstrimple   Prime Members   -  Reputation: 1718

Posted 07 May 2013 - 03:11 PM

It means almost nothing... unless you get sick or run over by a car. My family skated by for years without health insurance. We even had two babies while uninsured. We lucked out and came out ahead. We saved far more by not paying insurance premiums than we paid on checkups, vaccinations and even the delivery of two babies. If my wife had to have a c-section or there were other complications things would have been quite different.

 

Edit: Also, if you just lost your insurance and you want continued coverage, look into COBRA coverage.

Wow, so it is really possible to not have an insurance coverage until you get old. I know without insurance is financially risky but then seeing this post makes me think that I can still live without insurance. The cost of insurance is really something these days so I think if you're not an accident prone magnet, you can still live without having to pay for insurance.

 

Sorry, that's not the point I wanted to get across. It's really going to be random. Even if you are the pinnacle of health, you can still be involved in an accident of some sort which can ruin you financially. There are a ton of things which could have gone wrong for us and put us in a very bad situation, but we got lucky. A friend of mine has three kids and all three of them had to be delivered via c-section. That alone could have added up to well over a hundred thousand dollars in medical bills. Fortunately he had some coverage but was still on the hook for close to $10k due to coinsurance. 



#32 VladR   Members   -  Reputation: 722

Posted 07 May 2013 - 04:05 PM

A friend of mine has three kids and all three of them had to be delivered via c-section. That alone could have added up to well over a hundred thousand dollars in medical bills. Fortunately he had some coverage but was still on the hook for close to $10k due to coinsurance.

My former colleague had a million dollar baby. The complications in the delivery resulted in many complex and advanced procedures and prolonged (multi-month) stay in the hospital.

 

The bill was over $1,000,000

Thanks to insurance, he had to pay only about $7k...

 

 

Everybody thinks it can't happen to them. Till it actually does....


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